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Bermuda's Two Hospitals

Taxpayer-financed with both employers and employees paying for significant monthly healthcare insurance

What the new King Edward VII Memorial Hospital (KEMH), presently under construction, will look like, possibly under a new name.

By Keith Archibald Forbes (see About Us) at e-mail exclusively for Bermuda Online

To refer by e-mail to this file use "bermuda-online.org/kemh" as your Subject

See also Bermuda's Health Support Groups by the same author.

About today's two Bermuda hospitals and services

Newcomers, including those from the United Kingdom, should note there is no equivalent in Bermuda to a treasured national UK institution, the National Health Service (NHS) - see http://en.wikipedia.org/wiki/National_Health_Service - that started in 1948. There, State-funded NHS provides free hospitals and health treatment to all Britons including free prescriptions and free dentistry and eyesight matters for low-paid Britons, and is embraced by all political parties. While grumbling about its perceived slow service is widespread - and planned government reforms are controversial - its egalitarian ethos is a matter of national pride.

Thus, Bermuda's King Edward VII Memorial Hospital, above and below, is not in any way part of the UK's NHS and its hospitals system. Bermuda is the only country in the world where the residents and visitors pay not once but three times for hospital and medical services. In the USA, where hospitals are privately financed built and operated, patients pay for all services they use. In Canada, Australia, New Zealand, the UK, Europe, etc. the great majority of hospitals are financed by taxpayers with hospital and medical services included in the taxes paid. But in Bermuda, taxpayers pay first for the building and operating costs as part of their taxes; again in hospital fees and services they use on an as-needed basis; and also in the health or major medical insurances they all must pay by law to either the government or to private and local insurance companies.

Staff at the two hospitals number over 1500. Bermuda has audiologists, chiropodists, chiropractors, dentists, dental technicians, dieticians, medical doctors. There are also emergency medial technicians, medical laboratory technologists, midwives, nurses with SRN status or equivalent or enrolled, occupational therapists, optometrists and opticians, dispensing opticians, pharmacies, pharmacists, physiotherapists, radiographers and speech-language therapists. Under the Nurses Act 1969, all nurses, whether registered (SRN or equivalent) or enrolled, are required to renew their licenses on an annual basis. The Medical Program at KEMH has an Annual Review and Awards Ceremony, sponsored by the Bermuda-based prominent international corporation Merck Sharpe and Dohme. It provides thousands of dollars a year in awards as part of a commitment to Continuing Medical Education at KEMH. 

King Edward VII Memorial Hospital (KEMH)

EMT staff at KEMH

The main hospital, KEMH is Bermuda Government owned and operated. Point Finger Road, Paget Parish DV 04, Bermuda. Postal address P. O. Box HM 444, Hamilton HM BX. Phone (441) 236-2345. Fax (441) 236-2213.  KEMH is operated by the Bermuda Ministry of Health and Family Services, via the Bermuda Government-appointed Bermuda Hospitals Board (BHB), a publicly-funded quango (quasi autonomous non-governmental organization) established under the Bermuda Hospitals Board Act, 1970. The BHB is not a private business. It is a quango, owned by the Government on behalf of the people of Bermuda and administered by a board appointed by the Government on behalf of the people of Bermuda. It is funded entirely by the people of Bermuda by way of direct payments, insurance, donations and Government subsidies. Its employees are paid by the people of Bermuda. However, salaries and bonuses of senior managers of the hospital are kept secret from taxpayers. It has a Bermuda Government-approved Board and a Chief Executive Officer, responsible for King Edward VII Memorial Hospital and Mid-Atlantic Wellness Institute. At the heart of both organizations is high quality care to all patients. With approximately 1,700 employees, the Bermuda Hospitals Board is Bermuda’s second largest employer. King Edward VII Memorial Hospital and Mid-Atlantic Wellness Institute are the only healthcare organizations in Bermuda accredited by Accreditation Canada, an independent organization whose role is to help hospitals examine and improve the quality of care and service they provide to their clients. In addition to providing an extensive list of services for the community, the Bermuda Hospitals Board is part of a referral network that includes some of the world’s leading specialist hospitals. For more information, please log on to www.bermudahospitals.com

It is an Associate of the American Hospital Association. It has been accredited since 1972 by Accreditation Canada, formerly the Canadian Council on Health Services Accreditation, but does not appear on the latter's website. 

January 9, 2013. The final cost of Bermuda’s new hospital will prove higher than many expect, the new Health Minister has warned. But she promised to be keep the public informed as to where the money is being spent. This week, Health Minister Patricia Gordon-Pamplin vowed to press ahead with releasing BHB officers’ wages as part of the Board’s accounts reporting. Responded BHB Chief Operating Officer Venetta Symonds: “BHB remains committed to meeting the obligations mandated by the Hospitals Act. We are currently also in the final weeks of our Corporate and Clinical Governance Review, which will include recommendations regarding transparency and accountability.” Ms Symonds said she would work closely with the Board and the Minister to ensure that “an appropriate level of disclosure is provided. Our financial statements for the fiscal year 2011/12 are currently in the final stages of being audited. As soon as this process is complete, the Annual Report will be compiled and produced. It will go through its usual process through Cabinet and then the Houses of Parliament, at which point it will be made widely available to the public. At a time when cost containment is a top health concern, Ms Gordon-Pamplin also vowed to make good on One Bermuda Alliance calls for the salaries of Bermuda Hospitals Board officers to be made public. While in Opposition, the OBA chastised Government for its tardiness in releasing BHB financial statements. Ms Gordon-Pamplin this week affirmed the OBA’s bullish stance as Opposition on the release of wage figures. “Absolutely,” said the Health and Seniors Minister, when asked if she would follow through. “The BHB legislation requires disclosure.” Previous administrations have published wages as a lump sum, which the OBA maintained wasn’t sufficient. Ms Gordon-Pamplin conceded: “Obviously, there are some things that may need to be relatively confidential. However, with that said, I think that when we are spending public money, we have an obligation to let the public know where that money is going. If you’re spending my money, I want to know where it’s going. That’s just the way it is. We have made that commitment to transparency.” Although the new hospital facility’s original design and construction costs are given as $247 million, the project’s complex financing as a Public-Private Partnership (PPP) carry significant long-term costs. “From an accounting perspective, historically, PPPs end up costing more,” Ms Gordon-Pamplin said. “That’s just the nature of it. The people who have put their money up front want a return on their investment, which is perhaps not an unreasonable expectation. The fact is that given the budgetary constraints that we have operated under, given the economy as it is, there is no way that we could have afforded to build the hospital. What’s interesting is that within the debt number that we have heard, the hospital in not included — because it’s deemed to be, within the accounting jargon, an off-balance-sheet transaction with the PPP. So it’s going to perhaps end up costing us more, in the long run.” The hospital remains on-budget, and scheduled to finish next year, she said. “But the budget number that exists for the construction of the building, you can be assured that is not the final amount that will have to be paid at the back end for the cost of the construction. I still have to get a handle on the exact amounts that we’re dealing with — but I expect it to be high.” In the wake of an acrimonious election campaign which saw a war of words over the FutureCare seniors’ insurance programme, the Minister reiterated that the new administration has no intention of scrapping the programme. “Election campaigns bring out the worst in people as they jockey for position,” she said. “There was a big advertising campaign by the PLP that we were going to take away FutureCare. That has never been the intention of the OBA, and it’s certainly not the intention of the OBA Government.” Government’s aim now is to “make it fair, so that people who are getting specific benefits are paying the same amount. While one cannot fault people for making the most of an opportunity that’s presented, I think there are people who are harder done by who have a greater need than others. We want to look at the entire concept. Sustainability is important.” Another legacy of the previous administration is the legislation banning upfront payments for medical treatment, which Ms Gordon-Pamplin said made eminent sense. “The one thing that you will not get us doing is throwing out the baby with the bathwater. If there is a policy that exists that makes sense, we obviously will allow it to continue.” However, she said, the system would need tweaking: “I do believe that we have to try to broker something where there is a little bit more latitude on behalf of service providers, such that people do not feel as if they have to do without healthcare simply because they do not have to $20 or $30 or $40 for the co-pay. It’s something we have to work with. If we have to tie it in with Financial Assistance, then we just have to make it robust. I don’t want people being ill just because they don’t have a dollar.” Ms Gordon-Pamplin could offer no advance details on healthcare expenditure in next month’s Budget. “We have to recognize the fact that I can’t spend any more money than is made available to me,” she said. “And we can’t have any more available to me than exists from a budgetary perspective.” Promising a healthcare system based on “sustainability and equity”, she added: “What we want to make sure is that the people of Bermuda get the best bang for their buck, if I can be so crude as to put it that way. It’s important to look at everything, from the cost of pencils to the cost of imaging.”

On March 13, 2012 it was announced that construction of the new hospital had so far injected $35 million into Bermuda’s economy, with $125 million spent so far on construction orders. More than 60 percent of the hospital construction workforce consists of Bermudians, or spouses of Bermudians. The workforce averages 90 daily; at the height of construction, that will rise to 250. With construction of the new hospital on the doorstep of the existing hospital having been a challenge, the impact of noise and dust was being kept to a minimum, with measures such as air filtration inside the hospital, and washing of the wheels of vehicles before they leave the site. Faults in the limestone at the site had required 4,300 cubic yards of backfill. Mock-ups of facilities such as a trauma area, ambulance bays and patient bedrooms, have permitted modifications of designs. Equipment purchases are expected to run up $40 million, with stringent reviews of requests already in place.  Construction at King Edward VII Memorial remains on target for completion in 2014. At that point, the Bermuda Hospitals Board (BHB) must pay project managers Paget Health Services $66.7 million. The BHB has been increasing hospital fees by one percent annually, over five years under an agreement formalized in Cabinet back in 2009, in preparation. The Bermuda Government's 2012-2013 Budget has a spending cap of $104 million for KEMH but it does not mean people will be denied services. It’s a paradigm shift. There will no longer be a free-for-all. Hospital use for 2011/12 had exceeded estimates. As well as the new cap on the KEMH subsidy, the BHB had piloted a Memorandum of Understanding with a local insurer. With some of the risk transferred onto the healthcare provider, it gave more inventive to the BHB to ensure careful use of funds. BHB results of a three-year survey showed patient satisfaction continually rising. Nurses have historically been in short supply. Bermuda has 530 registered nurses, and BHB is aggressively courting Bermudian medical professionals from overseas, as well as promoting further training at home. Meanwhile, “fast tracking” incoming emergency room patients resulted in 88 percent of patients getting a hospital bed with in six hours. A new food delivery system had addressed a key problems with patient satisfaction, with a new kitchen system in 2012. Once the hospital redevelopment has progressed further there are plans to move the maternity ward next to the Operating Room. This means that mothers in labour will no longer have to be wheeled through the public corridors and taken in an elevator to the Operating Room. There is a prospect of a new birthing centre, possibly with a birthing pool, after requests by mothers in the community. For the Agape House hospice, BHB is adopting the Liverpool Care Pathway, the latest model of best practice to comfort dying patients and their families. The Island’s low rate of blood donation has caused concern. Bermuda’s total blood donor population of 1,107 is less than half that of comparable western countries. A total assessment of BHB’s information technology has been completed, and electronic health records are to be implemented at both hospitals. BHB will hire an expert to oversee the procedure.  The Queen Elizabeth Nursing Residence is increasingly unsafe and demolition is the preferred option, but due to the recession, BHB believes this can be put on hold. At the Mid Atlantic Wellness Institute (MAWI) the Mental Health Plan is based on the recovery model. Assertive outreach teams are now able to visit patients in their homes. Part of this can be seen in the Budget with the allocation of $120,000 for vehicles to outreach teams. The team also attends both Government senior schools to assess students, and a residential team is in place to serve group homes. All 74 of MWI’s resident learning disabled clients, who formerly lived on site at MWI, have transferred to a group home in the past year.

In February 2011 the BHB cut short its multi-million dollar five-year contract with Kurron Shares by 18 months to save money. It cost Bermuda $13.5 million over five years. 

In late 2010 the Bermuda Hospitals Board (BHB) signed a project agreement for the new hospital site, now being built (see photo at top of page). The agreement with Paget Health Services (PHS), a consortium of experienced local and international firms, allows them to design, build, finance and maintain the new King Edward VII Memorial Hospital building at the existing site. The new hospital is expected to begin caring for patients in 2014. It is expected to cost over $260 million. It was announced in December 2011 that the first year cost alone to taxpayers will be $66.7 million. There will be a 30-year payment schedule.

The partnership between BHB and PHS includes a three-year construction phase and 30-year maintenance phase. The new building will include 90 single-occupancy en suite patient rooms, Bermuda’s first dedicated day surgery unit and ambulatory care services like oncology, dialysis, asthma and diabetes management. It will also include diagnostic imaging services and a new emergency room and utility plant.

BHB will make its first payment for the hospital redevelopment in 2014. Health Minister Zane DeSilva told the House of Assembly under the agreement between Paget Health Services (PHS), the company that will be building and maintaining the property, and the Bermuda Hospitals Board (BHB), no money will exchange hands until the construction is completed. PHS pays for construction of the new hospital building, and the BHB pays nothing until it is complete in three years’ time to BHB’s specifications. BHB will retain ownership of the land and building.

In 2007, medical consultants Kurron Shares of America Inc won a five-year $13.5 million contract to help BHB develop a long-term health care strategy for the Island, beating a bid by world-renowned Johns Hopkins Medicine International. The decision prompted criticism from doctors, who claimed Kurron Shares was “minor league.” Also terminated was physician support contract with Greeley, which was not renewed in 2011. A number of other smaller contracts have either been terminated, not renewed or reduced. In total, net savings per annum are expected to be in the order of $4 million.

The goal is to improve efficiency and find appropriate operational cost savings, while continuing to improve health care services.

The continuous review is part of BHB’s commitment to consistently provide value to the community in the face of rising health care costs and the current economic challenges in Bermuda. It also reflects BHB’s responsibility to be prepared to meet the financial obligations of the KEMH Redevelopment Project, which includes making repayments for the new hospital facility from 2014 and funding the revitalization of the existing KEMH facility. BHB’s succession planning programme has identified Bermudians for senior leadership positions that were once held by consultants. With plans for the new hospital facility approved and a contract signed, the timing was right for a full review so that we only maintain those contracts whose role remains vital for us to meet the long-term health care needs of Bermuda. The Ministry of Health spent approximately $19.4 million on consultants between April 1, 2008 and January 31, 2010.

Bermuda-based Air Ambulance services have been discontinued and will not be able to fly again unless Government provides some money to help. The Bermuda Air Medivac plane has not flown since November 2011. The service was dealt a double blow by a declining number of patients and competition from cheaper US services. The air ambulance, which was set up in 2004, made 500 trips to take sick people for specialist medical help overseas before it folded. Patients ranged from head injury and stroke victims to cardiac cases. Meanwhile, the plane which ran the service, which was purchased with a charitable donation, remains in New York and may eventually be sold. Earlier, in the event of an emergency air evacuation from Bermuda to the USA or Canada, for medical services that cannot be performed in Bermuda, Bermuda Air Medivac Ltd was the operator of Bermuda's only emergency aircraft. A well-known philanthropist, David Barber, donated $2 million in 2005, in memory of his wife Mary, to buy an 11-seater jet for the company. Before the initiative, those critically injured or seriously ill had to wait for air ambulances based in the United States and Canada to fly to Bermuda and transport them off the Island.

Services include:

• Ambulances. All have automated external defibrillators (AEDs). They are portable devices that under medical supervision deliver a small electrical shock to restore normal heart rhythm during sudden cardiac arrest, a condition that kills countless patients a year. The average survival rate world-wide for sudden cardiac arrest is just 5 percent, but with fast treatment and an AED, there is a greatly improved chance of survival. The operator of an AED turns on the device and places two pads on the victim's chest. The machine assesses whether the heart is "fibrillating" or quivering instead of beating normally. If an abnormality is detected, the AED prompts the user to push a shock button to deliver a shock to the heart. If it does not restore normal rhythm, the unit repeats the process. An AED won't deliver an electrical charge to a person who has simply fainted and does not have fibrillation. Many AEDs have now been imported to Bermuda, thanks to a resident Australian philanthropist. In most countries that have AEDs - but not yet in Bermuda - "Good Samaritan" laws protect people who operate AEDs to treat a cardiac arrest victim.
• Angiography.
• Asthma
• Bermudian medical  students. Those returning to the Island enjoy better opportunities for work at KEMH than many of their overseas peers.
• Blood Clinic. Created in April 2012 by KEMH's cancer specialist/oncologist/haematologist Dr. Paul Coty and colleagues, to help with blood diseases. Until then, patients had to travel overseas for specialist attention. Local GPs sought out Dr Coty because it is well known in the medical community that oncologists are usually also blood specialists. Dr Coty said he thought it warranted a separate clinic, because people with these blood diseases were not ill in the same way that many cancer patients are. He said it would be better not only for the patients with the blood disorders but also for the cancer patients, to separate them. The clinic runs once a month on the second Thursday of the month. 
• Cardiac Diagnostic Unit. With a Cardiac Rehabilitation Specialist and Personal Cardiac Patient Folders of cardiac condition, family information, prescriptions, etc. It opened officially in August 2002. Patients undertake a stress test on a unit under the supervision of their doctor. The unit is good but there is no cardio-pulmonary rehab unit and patients are expected to start an exercise programme that is not professionally supervised.

• Cervical Cancer Screening. Cervical cancer is believed to have a very good recovery rate when diagnosed in time. In 2010, there were 11 cases of severe pre-cancerous lesions (carcinomas that cannot spread) in Bermuda and one case of invasive carcinoma (a carcinoma that can or has already spread). KEMH is hoping to see these figures improve greatly  with the introduction of the ThinPrep Imaging System with Dual Review, an advanced cervical screening system. Each Papanicolaou [Pap] test is now analyzed by the new system and then screened by a skilled cytotechnologist. Cells of interest are highlighted for the technologist to review, helping them to better focus their skills on pre-cancerous cells. This new method improves disease detection and enables early treatment interventions to prevent cancer. The system is already in common use in the United States and is thought to be the most accurate type of testing currently available for cervical cancers. The Bermuda Hospitals Board (BHB) is the only laboratory in Bermuda offering this process. They handle around 7,500 screenings a year, about half of all screenings done in Bermuda. Not everyone’s Pap test comes to the hospital. They are either farmed overseas or sent to KEMH. The new ThinPrep system combines advanced computer imaging technology with human expertise to improve cervical cancer screening efficiency and performance. It is the first fully integrated, interactive computer system available to assist the experts in screening Pap test slides. All cervical cancer tests at BHB are now screened using this system. In general, doctors in Bermuda recommend beginning Pap testing when women become sexually active. Women with certain risk factors may require frequent testing and are encouraged to discuss cervical cancer screening with their healthcare provider. These risk factors include a previous diagnosis of cervical cancer or a Pap test that showed pre-cancerous cells, exposure to diethylstilbestrol (DES) before birth, HIV infection and a weakened immune system due to organ transplant, chemotherapy or chronic corticosteroid use. Women can request their doctor or gynecologists send their Pap tests to the hospital for testing in order to benefit from this new system. More than 30 published studies involving more than 500,000 patients have demonstrated improved performance using the ThinPrep system. Improved accuracy of testing means a better chance of early diagnosis and a better outcome for women with cervical cancer. The old method was simply that KEMH would receive the cell sample and a cytotechnologist would screen the pap test and diagnose it. With the imager, advanced computerized technology will select cells of interest that may be abnormal or atypical cells. It just highlights where they are, but it still needs a human being to look at the test. The combination of this computer technology with qualified cytotechnologists has yielded a more sensitive Pap test to more effectively find abnormalities. It looks for lesions, ideally to catch them at the pre-cancerous stage. The aim is to get the pre-cancerous lesions and identify the patients who need intervention before cancer develops. For pre-cancerous lesions there is no need for radiation, they are just removed by surgery. Depending on how severe, the patient is either closely followed up if they harbor a mild pre-cancerous lesion, or removal by surgery will be performed for severe but pre-cancerous lesions. It is only cancerous cases that need radiation therapy.  The pre-cancerous lesions are associated with the human papillomavirus virus (HPV) infection. In Bermuda, like many parts of the world, the HPV infection rate is very high. There is now an HPV vaccine offered that protects against many of the major strains of the HPV virus. The fact that KEMH seeing very low cervical cancer cases with high HPV infection rates reflects the effectiveness of the local cervical screening programme.
• Child's wagons. To transport children to the surgery room, to make the experience less traumatic. Donated by the Continental Society of Bermuda, a registered charity. 
• Diabetes. 
• Diagnostic Scanner. Brand new in February 2012, the $1.48 million GE Discovery 128-slice CT machine provides faster scan times and a reduction in radiation doses of up to 50 percent. The scanner is twice as powerful as the 64-slice machine at Brown Darrell clinic, making it the most powerful on the Island. The machine was donated to Bermuda Hospitals Board by Hospitals Auxiliary of Bermuda. CT scanning is a form of diagnostic imaging using X-rays at many different angles to get a picture of body tissue. BHB’s new state-of-the-art technology gives physicians the ability to see more anatomical detail in only a fraction of the time it took previously. The new machine also offers virtual colonoscopy, a procedure that displays images of the large intestine on a screen, permitting physicians to assess and diagnosis digestive conditions using a less invasive procedure than surgery. The lower radiation dosage reduces the possibility of healthy tissue being damaged. The most important aspect of the new machine is that it gives a clearer picture of what is happening in the body. It enables doctors to diagnose problems faster and more accurately. Blockages in blood vessels, for example, are clearly visible, allowing doctors and patients to know the precise location of the problem.
• Dialysis unit, new. Renamed and upgraded as the Dr. Beresford Swan Dialysis Centre, named after the local cardiologist who initiated it. But it is already in dire need of more space and, better facilities for the patients who benefit from their services.
• Digital UHF Telemetry Machine, at three stations in Cooper, Curtis and ICU wards. It enables patients to be monitored appropriately.
• Expressing room. A room specifically for mothers to express milk, or breast-feed. Opened in February 2011. Nestled in the back of the children’s unit on the second floor of King Edward VII Memorial Hospital (KEMH), the small space features pictures of mothers and babies, a desk, some shelves, a small fridge, a chair and some literature from the breastfeeding support group, La Leche League. Being in the children’s unit, sometimes the coos and cries of babies can be heard. 
• Heart Defibrillators. Nine were recently donated to the hospital by Australian millionaire resident Bruce Gordon, who also supplied many others island-wide.
• High Intensity Focused Ultrasound (HIFU). In Bermuda since 2010. A non-invasive alternative to chemotherapy. One of the ways in which Bermuda can actively explore the expansion of medical tourism as a way to fill Bermuda’s empty hotel beds. Cashing in on ‘medical tourists’ as well as their families and doctors looks set to be one of the recommendations of the National Tourism Plan. Medical tourism could be a major revenue generator. The medical tourism industry is big business across the world and was introduced at King Edward VII Memorial Hospital in 2010 with a new prostate cancer treatment unavailable in the States. Government is now working behind-the-scenes to “take things further” by actively promoting Bermuda as a medical destination. It is hoped that Bermuda’s struggling tourism industry will reap the benefits of large numbers of people coming for lengthy stays. Bermuda’s proximity to the US and the offer of recovering in a beachside setting are understood to make Bermuda an attractive destination for patients. Bermuda Hospitals Board (BHB) has previously announced that High Intensity Focused Ultrasound (HIFU) generated 1,000 bed nights for local hotels in its first nine months. And since 2011 45 HIFU patients have been welcomed to KEMH. Medical tourism could offer a boost to the Island’s economy (but note that the USA's Medicare does not cover overseas medical care.) Patients from North America would fly to Bermuda, for treatment or recovery, in the same way they currently travel to Europe, and UK visitors go to Europe or India, to avoid long waiting lists or high costs. From a quality perspective, BHB will only consider offering treatments and procedures to medical tourists that are evidence-based and meet the standard of appropriate bodies. This means BHB will review potential medical tourism opportunities extremely carefully. However, the potential is there to benefit the hospital and Bermuda. It can also help with recruitment as local healthcare professionals will have the opportunity to work on some quality, leading treatments and procedures with international specialists.

Medical tourism with HIFU, above

• Hospital waste. All hospital waste is piped from the hospital across the South Road into the from City of Hamilton underground piped sewage system at the sea end of Seabright Avenue, Paget and then dumped untreated into the sea. 

• Hyperbaric chamber.  Not all hospitals have one. Bermuda's is good. For decompression sickness. It can strike both local and tourist divers. Our bodies are designed to breathe freely on land. Once we go underwater there is a change in atmospheric pressure. The pressure increases the further down we go. Scuba divers take tanks of compressed air with them to breathe while underwater. The air contains oxygen and nitrogen (it may also contain helium). Oxygen breathed in is necessary for the body's cells to function and gets used up, nitrogen however gets stored. The deeper we dive the more nitrogen from the compressed air moves through the lungs and into the blood and body tissues. The longer we stay in the deep, nitrogen dissolves and accumulates first in those tissues with the most blood flow, eg the brain, and more progressively the fatty tissues of our bodies. On longer dives some or all of these tissues become saturated with nitrogen and will not accept any more. As we swim back to the surface, there is a delay before saturated tissues start to release nitrogen back to the blood. This is what causes decompression problems. As indicated by its name, the problem is in decompressing, moving from high pressure to low. When a critical amount of nitrogen is dissolved in the tissues, a reduction of pressure, caused by moving to the surface, induces the dissolved gases to be released and form small clustered bubbles in tissue cells, tissue spaces and blood. Ascending too quickly causes the dissolved nitrogen to return to gas form more quickly increasing the number and size of the bubbles. This return-to-the-gas state happens while the nitrogen is still in the blood or tissues. This causes the characteristic decompression sickness pain and can also damage cells.

KEMH's Hyperbaric unit

• Image Analysis Machine, as a diagnostic addition/extension of the Stress and ECG tests.
• Lung cancer screening. If you’ve been a heavy smoker or have been subjected to second-hand smoke in concentrations where you feel you might has well have been smoking yourself, you might be concerned that you’ll develop lung cancer or worse, that you’ve already got it. Now being offered not at KEMH but at the Brown Darrell Clinic, with the CT scanner. The service is offered in partnership with the Lahey Clinic of Massachusetts. Patients have to be referred by their doctor for the scan. The local physician fills out a form which goes to a radiologist specialist at the Lahey Clinic. Based on the information from the local physician, the Lahey specialist gives specific instructions on how to carry out the scan including where the patient should be positioned. If follow-up is necessary, patients are not limited to having it done at the Lahey Clinic. The files are kept electronically and can be shared with any facility using the same system. Many Bermuda patients go to Johns Hopkins. They will have a patient number which enables their results to be shared with other facilities on the PAC (picture, archiving and communication) system.
• Mammography. Recently upgraded to new digital equipment, offers digital mammograms. The machine is equipped to provide stereotactic biopsies — the next diagnostic step following a suspicious mammogram. In Bermuda in 2009, breast cancer was the most commonly registered type of cancer in women and it was the third highest cause of death from cancer. A woman's risk of breast cancer increases with age. Having an annual mammogram after reaching 40 is one of the best chances of catching breast cancer early. It should be part of an annual wellness check, just like a pap test for cervical cancer. 
• Magnetic Resonance Imaging (MRI) Department. New in 2003. It complements CAT examinations.
• Maternity Unit.
• Medical Clinic, now closed. It once provided a safety net for seniors unable to pay HIP or FutureCare, was closed several years ago by former Premier Dr Ewart Brown. This clinic provided physicians, nursing care, medications and screening all under one roof at this hospital, even transportation was provided.
• Patients Bill of Rights. See http://www.bermudahospitals.bm/bhb/patient-visitor-info/patients-rights.asp. And Rights of Involuntary Patients. See http://www.bermudahospitals.bm/bhb/patient-visitor-info/involuntary-rights.asp. And Patients Responsibilities. See http://www.bermudahospitals.bm/bhb/patient-visitor-info/patients-responsibilities.asp. 
• Patients who incur very serious life-threatening problems who have insurance or the means will continue to be sent to Johns Hopkins in Baltimore, Maryland or Lahey or Spaulding in Boston, Massachusetts, by air-ambulance, if needed.
• Prostrate Cancer Treatment via High Intensity Focused Ultrasound (HIFU), unavailable in the USA, yet to be endorsed by the US Food and Drug Administration. Has brought many medical tourists as well as their families and doctors to the Island since being made available in 2010. This is said to have generated a total of 1,000 bed nights for local hotels. Through a device called Sonablate (R) 500, HIFU works by destroying prostatic tissue through extreme heat, produced from focused ultrasound waves. It is described as a “minimally-invasive” prostate cancer treatment. US HIFU is a private health care company based in Charlotte, North Carolina. It says that compared to other therapies such as surgery or radiation, HIFU has less significant side effects. Already, more than 30 countries have medical facilities which use the technology.
• Radiology. With a radiology information system from Arizona-based Misys Healthcare Systems to make film unnecessary. All X-rays and cat scans now go directly to a computer.

• Scanner. In 2009 The Hospitals Auxiliary of Bermuda allocated $500,000 toward Bermuda Hospitals Board's purchase of a new 64-slice CT scanner. The scanner, which has four times as many detectors as a typical single slice CT scanner, combines unequalled image quality with remarkable speed. It can produce detailed pictures of any organ in a few seconds and provides sharp, clear, three-dimensional images, including views of blood vessels, in an instant. Introduction of the 64-slice CT scanner at the hospital will extend over the 2009/10 fiscal year, as it will require renovations in the CT area, along with the addition of a digital image archiving system, needed to manage the vast number of images produced by the new equipment.

• Special Care Baby Unit.  For premature and other needy new babies. Located in the maternity ward, unlike in large hospitals abroad where it can be some distance away from a maternity ward.   

• Ultrasound. A new portable unit was imported, especially for difficult pregnancies.

• X-ray equipment, new in January 2013 was purchased thanks to the donations of the Hospitals Auxiliary of Bermuda (HAB). The new equipment is intended to replace a 16-year-old system at KEMH, which was becoming increasingly difficult and expensive to maintain. It includes a replacement fluoroscope which enables an imaging technique that uses X-rays to obtain real-time moving images of the internal structures of a patient, called fluoroscopy. Fluoroscopies are frequently used to investigate the gastrointestinal tract or urinary tract, or provide an arthogram of joints. While the Hospital Board paid $57,855 to install the system, the cost of the donated equipment itself cost $419,864, all raised by the HAB through membership dues, The Pink Cafe, The Gift Shop and The Barn. HAB donates around half a million dollars to the Hospital Board annually to purchase new equipment, along with supplying the hospital with numerous volunteers. This donation helped us replace equipment that was increasingly challenging and costly to maintain. The impact to patient care resulted in delays due to high levels of maintenance, and extended downtimes. The HAB’s donation enabled KEMH to improve quality with new technology and relieved the escalating financial burden of keeping aged equipment running. The equipment will improve the quality of care provided by the hospital, and will be moved to the new hospital building when opened in 2014. The new equipment updates the technology and enables KEMH to improve the quality of the images and reduce the amount of contrast and radiation patients are exposed to in each test.

Mid Atlantic Wellness Institute (Formerly St. Brendan's Hospital)

44 Devon Spring Road, Devonshire FL01. P. O. Box DV 501, Devonshire DV BX. Phone (441) 236-3770, fax (441) 235-9383. Also Bermuda Government owned and operated. It includes a detoxification unit, 8-bed. At the Turning Point Center.

Registration required for all newcomers and locals

To better regulate health professionals, there are now powers to suspend or bar people for misconduct. The Professions Supplementary to Medicine Amendment Act 2006 , enacted by the Bermuda legislature, ensures practitioners are competent and stay up to date with the latest techniques and that there are more teeth for dealing with complaints. The primary purpose is to ensure they meet established standards of education, training and professional conduct and are educated about new procedures that come along. Covering such professional categories such as physiotherapist, occupational therapist and diagnostic imaging the Act establishes a Council for Allied Health Professionals to promote patient interests and exercise discipline over practitioners. A Preliminary Proceedings Committee has been set up to investigate complaints – serious complaints will then be referred to a Professional Conduct Committee which can hand out fines of up to $2,000, suspend a person’s registration for a year or even bar them from practicing. 

Registers and/or interested organizations include

Only persons on their respective registers are recognized to practice in Bermuda. All involved who need or want further details about registration should contact the Administrative Assistant to the Council, Ministry of Health and Family Services, P. O. Box HM 1195, Hamilton or telephone (441) 236-0224 extension 3441.

Accommodation for doctors and nurses from abroad

Some accommodation is available for incoming non-Bermudian doctors and nurses. Incomers to Bermuda should know Bermuda is the wealthiest place in the world according to the World Bank. Aspiring medical newcomers should check for themselves and make appropriate comparisons to determine that terms and conditions of service generally are comparable and equivalent in accommodation, length of service, upward mobility, salaries, benefits and airfares to those offered in American, Australian, Canadian, Cayman Islands, European and New Zealand hospitals. At all such places abroad, for academically and professionally qualified staff standard attractions and contracts include all local Board of Nursing or MD-certified or equivalent fees paid, accommodation (one-bedroom or more) for a stipulated period of time, round-trip air fares once every year or two, good local transportation options and financial assistance if merited, good living conditions and possibly a sign-on bonus.

Health Care Costs presently to Consumers and types of cover

Once, the hospital system was private sector. At that time, it was supported by charity with the efforts of visitors like Mark Twain and British Army then in Bermuda. Today, the costs to all who need the hospitals of Bermuda are not included in national direct and indirect taxes as they are in Canada and the United Kingdom. There is no national health plan in Bermuda.

Prudent visitors will bring spare money in US Dollars, travel insurance and health insurance to cope with possible unexpected problems including accommodation in an emergency medical situation or a death. Visitors from the United Kingdom should note that the National Health Service of the UK does not apply at all in Bermuda. Nor does it have an equivalent. Medical costs here are as high as, often higher than, those in the USA. Affordable accommodation in Bermuda for such emergencies, especially from April to November, is extremely difficult to find. Every week, visitors suffer emergencies. Many say they do not make any contingency or emergency plans. They claim they have no money and no health and travel insurance for unexpected problems. (When locals go the USA and elsewhere, on cruises or by air, they must either have such a plan or be prepared to pay full medical costs themselves).

In Bermuda, There is no insurance coverage for birth control, only for abortions in certain approved circumstances.

Working newcomers are not given a choice by their employers of local healthcare plans but must accept the plan and its insurer offered by their employer. They will not be allowed to opt out of the local plan if they belong to any non-local healthcare plan.

All employees, managers, officers, directors, etc, working in Bermuda whether local or expatriate must have (a) compulsory employer-provided medical insurance for themselves and their unemployed spouses and children and (b) that it must by law be provided by a Bermudian (not just Bermuda-based) insurance company in Bermuda at least 60% beneficially owned, managed and directed by Bermudians and approved for such insurance. 

All Bermudian health/medical private sector insurance companies - for example, Argus Group, BF&M Insurance Group and Colonial Insurance Company, Kitson Benefit Services - offer more than just the minimum benefit. Policies, including the Government's Hospital Insurance Plan (HIP) policy, also contain an extra layer of major medical cover. It is up to individual insurance companies how much they charge for the cover above the minimal level.

Multinational insurers with a registered office in Bermuda are not allowed to compete with local companies for any local business including hospital or major-medical plans. Bermuda's health care insurers must be local (namely, Bermudian). 

Newcomers from Britain should be wary of trying to buy medical insurance coverage from a Britain-based or not Bermuda-based insurance company or broker. It could mean partial or more extensive duplication of coverage. 

Bermuda now has a more expensive health care system than all 25 countries in the Organization for Economic Cooperation and Development.  The UK, Canada, Germany, Portugal and Spain all pay significantly less. Figures released in July 2010 show Bermuda's average annual per capita health expenditure is $4,989 compared to $4,687 in the USA; $2012 in the UK; $1,713 in Portugal; $2,892 in Canada; $2,761 in France; $1,800 in Spain; and $980 in Hungary. In the late 1960s Bermuda picked a health care model based on private insurance, like those in the US and Switzerland. It may be hugely more expensive than the state-provided national health service systems in Canada, USA, etc but one advantage is no or much shorter waiting times when going to doctors' offices or awaiting operations.

From April 1, 2011 the cost of the minimum (or standard) health insurance package in Bermuda (see below for more details), if offered by the Bermuda Government instead of a private-sector Bermudian insurer is to increase by 6.8 percent. This was confirmed by Minister of Health Zane DeSilva. All insurance premiums - not just the standard one below - offered by all Bermuda-based employers via all relevant Bermudian insurers go up by at least the same amount, if not higher.

The law states that the cost of the premium must be shared equally between employers and employees, although some employers pay more. The news means that some employees will face up to $8 per month extra being deducted from their pay packets for health cover. Since 2004 the standard premium rate has more than doubled. It grew more than 12.6 percent every year between 2004 and 2010.

The rate above covers the minimum healthcare package, the standard hospital benefit. The law in Bermuda requires all employers to provide this minimum level of health insurance for their employees and non-working spouses and to cover at least half the cost of this insurance. It covers public ward hospital care, certain outpatient services such as laboratory tests, the ambulance service and care at the mental hospital. However, most employers provide benefits well in excess of the minimum for both employees and their children. 

Bermuda's Members of Parliament have approved a succession of significant rises in hospital fees in recent years. The Bermuda Hospitals Board (Hospital Fees) Regulations state what they are currently.

Hospital Insurance Plan (HIP)/FutureCare and their costs/premiums. For all newcomers to including retirees and residents in Bermuda without a partially local Bermuda employer-funded private Health Care Insurance Plan, not in addition to the latter). Operated by the Bermuda Government under the Hospital  Insurance Act 1970, funded by the government's Health Insurance Fund (HIF) and government's Mutual Reinsurance Fund (MRF), overseen by the Hospital Insurance Commission and administered by the Social Insurance Department, Government Administration Building, 30 Parliament Street, Hamilton HM 12. Phone 295-5151 extension 1146, 1130 or 1137. The current standard premium rate for this coverage and what it covers and does not cover are published. It is a basic plan covering many Bermudians and others over the age of 65 and otherwise uninsured because of newcomer non-working status or termination of local employer/employee insurance coverage owing to retirement, or through unemployment. Many in Bermuda who are not affluent depend solely on their social security and if they pay rent as more than 40% of all residents do instead of owning their own homes, have to decide whether to pay for HIP or FutureCare and prescriptions or count on the help of relatives or do without food. In 2008 some benefits were improved. For example, funding for kidney transplants has increased to $100,000 while general outpatients can claim $500 a year towards their treatment. Policy-holders should still be aware that while HIP does not cover the cost of specialist visits which occur within a doctor's offices or during outpatient visits to KEMH, should they require a visit to an internal medicine physician, eye surgery or attend the bone fracture clinic at KEMH as an outpatient, they can now get some relief, of up to $500 to be applied to these types of specialist services and others for medically-approved procedures. In addition, on August 1, 2008 Government introduced basic dental cover under the insurance plan, in cooperation with the Argus Insurance Group. Access to dental services is a critical need for many seniors. The dental coverage offered by HIP includes basic preventative and diagnostic services, along with surgical and minor restorative dentistry work, funding 75 percent of expenses on qualified procedures. Generally, not covered at all is having  to go overseas to get treatment of a type not offered in Bermuda. Some Bermudians and other residents have spent over $100,000 for a 10-day stay at a hospital in  Boston or Baltimore. Health Minister Zane DeSilva announced that premiums for HIP and FutureCare were increased as of April 1, 2012. HIP Premiums increased from $385 to $390 per month, while FutureCare, the programme for seniors, saw its premiums increase from $375 to $385 per month for phase one policy holders. Premiums for phase two and three policyholders remain the same at $635 per month. The monthly premium is over 35% of the average local pensioners Social Security. The Minister said that FutureCare had ended its third year in a strong financial position but that claims were expected to increase significantly in future years. He said that the Ministry was acting on actuarial advice "to ensure the sustainability of the funds."

There is no Long Term Health Care Insurance offered at all by local insurance companies and those international insurance companies incorporated in Bermuda offering it in other countries even when their home offices are, for example, in the USA, are not allowed by law  to offer it in Bermuda. Many residents, whose major medical insurance through their employers stops, if they had it at all, when they reach 65, have had to spend many thousands of dollars of their own money overseas, with no insurance. Visitors who come on vacation or to see family or friends should be aware in advance that they are not entitled to any local health insurance employer-provided employee coverage or benefits. Not covered are services like ambulance fees, x-rays, doctors' consultations and reports, etc.

Proposed new National Health Care Plan

Not yet put into effect. Basics were unveiled in February 2011 by the former Government, which aims to ensure all residents have quality, affordable healthcare. Then-Health Minister Zane DeSilva said the plan would introduce “wide-ranging and profound” reforms to the Island’s health care system. It aims to make health care more affordable and improve access and quality care. Mr DeSilva said the reforms “address the long-standing concerns with the escalating costs of health care, and the inequitable burden placed on too many individuals and families. It pledges to ensure basic and essential care is provided for every Bermuda resident in 2013. The plan states universal access is “necessary” for the Island to achieve better health outcomes, such as improving life expectancy and reducing disparity. Eligibility will be determined on the basis of residence and will be defined by law. The package of services covered will also be defined in law. Another goal is to ensure that basic coverage includes urgent physical and mental health care, hospitalization, primary care, preventative care and maintenance. It will also include clinical preventative services like screening, counseling and treatment. The National Health Plan will also ensure health coverage contributions are based on ability to pay. This will allow health care costs to be affordable to all members of the community. It also changes the way health care is defined as treatment will no longer be considered a consumer good or commodity, but a “public good” that is accessible by need. Currently the Island compares well with other countries in the Organization for Economic Cooperation and Development (OECD) in terms of life expectancy, infant mortality rates and access to health care. But it fares poorly in terms of ensuring all residents have affordable health insurance coverage which provides a core set of services. Other goals include ensuring smarter use of overseas care, introducing an integrated health IT system, health promotion, and re-engineering the way health care is financed so it can be more cost-effective and ensure better value for money. When asked how the universal coverage would affect rates people currently pay, Mr DeSilva said: “Those who can pay will pay, and now those that are struggling to pay, we want to make sure they don’t pay or pay very little. The system we have right now is very unfair.”

The plan sets out 11 health sector goals to improve access, quality and efficiency, which will be implemented over the next two to six years, with specific goals.

• Universal access to basic health coverage shall be assured for all residents of Bermuda. 
• Basic health coverage shall include urgent physical and mental health care, hospitalisation, primary care, preventive care and health maintenance. 
• Health coverage contributions shall be based on ability to pay. 
• Streamlining use of overseas care to get the best value for money for the population. 
• Mechanisms to pay healthcare providers and ensure optimal quality to patients and maximum efficiency to the healthcare system. 
• An integrated health IT system including a range of information about demographics, medical history and billing. This shall be established throughout the health sector to improve efficiency and quality. 
• Implement strategies to meet the healthcare needs of people with chronic illnesses, and physical, cognitive and mental disabilities. 
• The quality of healthcare provisions shall be monitored and regulated. 
• Introduction of health technology shall be regulated to ensure proper level and mix of resources to efficiently meet the healthcare needs of the population. 
• Health professionals and organizations shall promote healthy lifestyles and maintenance of health conditions to curb the amount of chronic non-communicable diseases like heart disease, cancer and diabetes.

Health Care Statistics

It is believed Bermuda spends about $6,982 per capita on health care about 7.6 percent of the Gross Domestic Product (GDP). These statistics place Bermuda second in a list of countries in the Organisation for Cooperation and Development (OECD) on health care spending. The Island is second to the United States, which spends more than $7,000 per capita, or 16 percent of its GDP.

The Bermuda Health Council cites the following as a comparison in the number of health care providers here and in OECD countries for every 10,000 residents: 

• Bermuda and the US each have 24 physicians; Canada has 22, the UK 25 and Singapore, 15

• Bermuda has 72 nurses, the US 84, Canada 90, the UK 65 and Singapore 45

• Bermuda has 7 dentists, the US has eight, Canada 12, the UK five and Singapore three

• Bermuda has 13 pharmacists, while the US has nine, Canada eight, the UK six and Singapore three.

Health report

A recent health report - the Bermuda Government's Adult Wellness Report - showed that

• One in three islanders are obese, caused in part by unsatisfactory working conditions - bad air, excessive heat or cold, poor work space, long periods of standing or sitting - cause stress which leads to drink and drug abuse, heart disease and obesity.

• 12 percent abuse alcohol

• The six most frequent health problems are allergies, asthma, migraine headaches, tension headaches, depression and anemia. (But all this is contradicted by reports showing heart attacks and strokes as leading causes of death)

• Top health concern is AIDS and sexual diseases, with 52 percent tested for HIV. 55 percent say they receive no education or information from their doctor on sexual practices  or family planning.

• 30 percent of adults use prescription medicines every day

• 90 percent of women 40 and over have had a mammogram

• 95 percent of women 40 and over have had a pap smear

• 60 percent of men 40 and over have had a prostate exam

Referrals

Patients who need tests or treatments at bigger facilities beyond Bermuda are first referred by doctors then go by commercial air or air ambulance to hospitals overseas.  If patients are not covered by Major Medical insurance when they are referred to an overseas hospital, they have to bear the costs themselves. It will be very expensive. Such services are not provided under HIP in Bermuda. One overseas hospital is the world famous Johns Hopkins Hospital at 600 N. Wolfe Street, Baltimore, Maryland. Its superb, comprehensive Rehabilitation Center is available six to seven hours a DAY including Saturdays. Others include the Lahey Clinic, Massachusetts General, Brigham and Women's, all in MA; and for cardiovascular, the Washington Medical Center in Washington DC. 

Health related support groups in Bermuda

For people who have to live with disabilities or problems or both, their immediate caregivers and too often for survivors, including family, friends, co-workers or classmates, a strong support network is an essential part of good physical, mental and spiritual health. 

History of hospitals in Bermuda

1812. 1st Hospital. Royal Navy. Admiralty House, Long gone.

1818. Construction of the RN Hospital near the Dockyard, in the same pre-fabricated manner as the Commissioner's House. In addition to cast iron structural features, such as veranda columns, floor joists, and possibly cast and wrought iron roof trusses, some of the stonework for the building was the hard local limestone. A surgeon, doctors and medical staff were appointed and sent by the Royal Navy. During World War 2, the Royal Naval Hospital, Bermuda, treated and often saved the lives of many brought in from torpedoed ships. The Royal Navy left in 1950s. That hospital building ended its life as an egg farm, then finally was deliberately burnt to the ground by the Fire Department in November 1972. Part of it became the site for Lefroy House, for senior citizens.

1841. Planning of first Bermuda civilian hospital. . On 28 April, the Bermuda Legislature passed an "Act for the Safe Custody of Insane Persons charged with Offences. " It was the first local legislation to deal specifically with persons with mental problems. Persons charged, if found to be insane, were kept in custody until they could be sent to an asylum. In 1846, a further Act was passed to establish a hospital for the reception of "insane paupers." It enabled the Governor, Lieutenant Colonel William Reid, to buy land in a central parish for an asylum. Moved to and see under "St. Brendan's Hospital" in Devonshire Parish.

1848. Opening of first Bermuda civilian hospital -  the Lunatic Hospital (as it was then called, insensitively). Dr. Henry Josephus Hinson, a graduate of Edinburgh Medical School in Scotland, was the first medical superintendent. It remained in its original location for 22 years.

1864. A Board of Health hospital was established at Cedar Hill, St. George's, for victims of the Yellow Fever epidemic then raging in Bermuda.

1868. Re-location and expansion of former Lunatic Hospital, now St. Brendan's. It moved to its present location, the site of the former Devonshire College. Later, under Governor General Sir John Lefroy, the Devonshire College buildings were expanded after he convinced Parliament to spend £3,650 sterling to pay for additional work. A much larger facility was required from the beginning of the 20th century, especially during and after the two world wars. St. Brendan's became its official name, after the Irish saint born about 484 AD.

1850s. 3rd Hospital. British Army, Prospect. Building still there, British Army left in 1950s, continued as Bermuda Government-owned Old Prospect Hospital until 1971/72. No longer a hospital.

1894.  March 11, Hospital Sunday. 4th Hospital. Second civilian hospital. Patients of all classes who required hospital treatment were admitted to the little rectangular structure known as the Cottage Hospital which had only a handful of beds. It was the first civilian (but not military, as there were two) hospital in Bermuda. It was on elevated ground near the east end of Pembroke Parish on the Military Road from Fort Hamilton to Prospect. It subsequently became King Edward VII Memorial Hospital. See below.

1901. Port's Island Hospital for Boer War prisoners-of-war. Also used to house 3 German nationals interned and 58 German merchant seamen in the 1914-18 Great War.

1920. The first official Royal Visit to Bermuda was when Albert Edward, Prince of Wales (later, briefly, King Edward VIII) concluded his tour of the British Empire. It was the first of three visits to Bermuda by him. On this first occasion, one of his official duties was the opening of the King Edward VII Memorial Hospital on its present Paget location, formerly the much smaller Cottage Hospital in Paget Parish.

1941. First American hospital facility in Bermuda. American troops at the Castle Harbour Hotel brought with them a medical contingent of eight officers and men and established on a temporary basis on the first floor of the hotel an infirmary, not a hospital.

1941. August. First American Hospital in Bermuda. It was at what was was - is now, again - the Bermuda Biological Station for Research at Ferry Reach. The American Government obtained a lease of the buildings and grounds (with the biologists re-housed at the Government Aquarium, Flatts). A temporary American military hospital was established there. It was staffed by four physicians, a dentist and nurses, all US Army personnel. It was responsible for all members of the US Army Engineers and the thousands of workers involved in the building of the Fort Bell/Kindley Field Base.

1941. September. US Navy began construction of an Annex Clinic at the first US Armed Forces Base in Bermuda, in Southampton Parish. In 1993, it was closed and amalgamated with the Base Clinic at USNAS, St. David's.

1941. October. Work was begun by US Army Engineers on the building of an elaborate 150-bed permanent hospital at Fort Bell. It is no longer there but on the same site on which the present, much-newer, former US military hospital - but now abandoned, vandalized and vacant - now stands.

1942. When the Riddell's Bay Golf Club was a US Navy recreation centre during the war, a mobile hospital for the war-wounded was established nearby. It too saved the lives of many brought in from torpedoed ships. Others were brought in to the Royal Navy Hospital just outside Dockyard (now Lefroy House).

1943. May. The first US Military base hospital at Fort Bell was finally completed, but only with the bare essentials, notwithstanding its price-tag to US taxpayers of more than $1 million. But there were sufficient facilities at the new site to justify giving plenty of notice in advance of the closure of the infirmary at the Castle Harbour Hotel and the temporary hospital located at the Bermuda Biological Station.

1943. December 30. With completion of the first purpose-built hospital at Kindley Air Force Base (KAFB), Bermuda, the infirmary that had been established at the Castle Harbour Hotel was finally closed out and the hospital facility that had been in operation at the Bermuda Biological Station was also shut down.

1954. It was resolved by the US Military in Bermuda that the base hospital had to be demolished and re-built from scratch at US taxpayers expense again as it had become too much of a liability. Over time, it had been established its beams, concrete and other structures were riddled with rust and related problems, apparently with sea water instead of fresh water used for building, using shoddy construction techniques.

1956. June 21, 1956. Kindley Air Force Base (KAFB), Bermuda celebrated a major event, with Bermudian help. The occasion was the official dedication of the brand-new base hospital up to latest US hospital standards, on the site of the old building which had been demolished because it had incurred some major building errors and its foundations and walls were doomed. Its use was confined to civilian and military employees and personnel of the US Military Forces in Bermuda and their military colleagues at the British and Canadian bases in Bermuda. It was designated as the 1604th Hospital (and stayed that way until 1967 when it was downgraded to a dispensary). Vanguard Construction of the USA built the new building, at a cost to US taxpayers of more than US$1,500,000. It had taken almost two years to build, mostly with Bermudian labor, with the complete interior decoration work undertaken by the Front Street, Hamilton firm of A. S. Cooper & Sons Ltd. The grand opening, held under sunny skies outside the hospital's main entrance, was attended by His Excellency, Governor Sir John Woodall; a delegation from the USA including Dr. Frank B. Berry, then Assistant Secretary of Defense (Health and Medical); Major General W. H. Powell, Jr., Deputy Surgeon General, United States Air Force; and the Honorable J. B. Pine, the United States Attorney General. Also in attendance were the Hon. Sir John Cox, then the Speaker of the Bermuda House of Assembly, the Venerable Archdeacon Stowe, who performed the Invocation and the Right Reverend Robert S. Dehler, Roman Catholic Bishop of Bermuda, who performed the Benediction.

1965. June. King Edward VII Memorial Hospital (KEMH) present building was completed (added to greatly since).

1970. Bermuda Hospitals Board (BHB) established. It brought King Edward VII Memorial Hospital and slightly re-named St. Brendan's Psychiatric Hospital under one governing body. Today, both are owned and staffed by this specialist agency of the Bermuda Government. See Bermuda Government Boards. There is also a Bermuda Hospitals Charitable Trust (BHCT), shown in Associations in Bermuda, B Listing. More than 1,500 staff are employed by the two hospitals.

1971. Patients were transferred from old Prospect Hospital to newly opened Geriatric and Rehabilitation Unit at KEMH.

1995. When US Forces quit Bermuda, the former base hospital, by then demoted to a dispensary and Base Clinic, was abandoned.

1998. Additions to KEMH. They included new Surgical Wing, new Emergency Ward, Hospice, Intensive Care Unit, Pharmacy, etc. plus increased space for many Departments.

2005. 12th May. Mid Atlantic Wellness Institute (MAWI) became the new name of St. Brendan's Hospital in Devonshire.

2014. The new King Edward VII Memorial hospital, now being constructed at the same Paget location, is expected to open.